MEDICAL-SURGICAL 1, 2, 4 5. Diabetes Insipidus vs Synd.

of Inappropriate Diuretic Hormone

DI SIADH
Review
1. Foods high in Sodium, ALL ADH Decreased Increased
- Canned foods
Water intoxication >
- Processed/Instant foods Complication Hypovolemic shock cerebral edema >
- Tomato juice / Ketchup seizures & ^ed ICP
2. Top medications in the boards
Fluids Force 2 - 3 L/day Only 500 ml/day

3. Hemorrhage: blood loss of 500 ml/day Diagnostic Urine Sp gravity Urine Sp gravity
4. Kidneys Procedure (low) (high)
- Functions: Urine Diluted Concentrated
Normal Range Toxic Serum Sodium Increased Decreased
Digoxin 0.5 - 1.5 meq/L 2 1. Osmotic
diuretics:
Lithium 0.6 - 12 meq/L 2 Mannitol
(Osmitrol)

Aminophylline 10 - 19 meq/100ml 20 - Anytime of day

- Side/Fast drip

Dilantin 10 - 19 meq/100ml 20 2. Loop diuretics:

Acetaminophen 10 - 30 meq/100ml 200 Furesomide
(Lasix)

1. Vasopressin
Urine formation (Pitressin) IM

- Given in the AM >

- Regulates BP > activation of RAAS DOC prevent sleep
2. Desmopressin
disturbances

- Stages: PO / Intranasal
- IV push / PO

- Filtration: 125 ml/min (GFR) - IV effect: 5-10

- Reabsorption: 124 ml/min of ultra filtration mins

- Excretion/Secretion: 1ml/min - IV max: 6 hrs

- Side effects:
- Normal Urine Output: 60 ml/hr hypoK, hypoCa,
- Anuria: less then 30 ml/day hypoNA,
- Normal urine retained: 100 ml hyperurecemia,
hyperglycemia
*NV ICP: 0-15 mmHg

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6. Thyroids Gland 8. Benign Prostatic Hyperplasia (BPH)
- 2 lobes - Enlargement of prostate gland
- Located on anterior of the neck - Most common in 50 y/o and older
- Thyroid hormone: - Organs of genitourinary tract:
- Hypocalcetonin - Kidneys
- T3 (Tri-Iodothyronine) - Ureters
- T4 (Tetra-Iodothyronine / Thyroxine): most abundant - Bladder
- Urethra: 8-9 inches (M) ; 1-1.5 inches (F)
Hypothyroidism Hyperthyroidism
- Signs and Symptoms:
All are decreased All are increased - Nocturia (initial sign)
except weight and except weight and - Decreased urine output ; ^ed urine residual volume
menstruation menstruation
- Bladder distention
Appetite
Anorexia, but weight Hyperphagia, but - Urinary dribbling
gain weight loss - Backache
Skin Dry Moist - Complications:
- Sciatica (severe lower back pain)
Intolerance Cold Heat - Hydroureters
Menstruation Menorrhagia Amenorrhea - Hydronephrosis
- Kidney stones
Exophthalmos - Renal failure
- Puberty (9-21 y/o) - UTI: acid-ash diet > acidifies urine to prevent bacterial
multiplication
Female Male
- Eg. cranberry/orange/pinapple/etc. juice
Thelarche Penile/Testicular Enlargement 9. Pheochromocytoma: tumor of adrenal medulla
- Adrenal medulla (inner most) > secretes catecholamines >
Adrenarche Deepening of the voice
adrenalines (epinephrine & norepinephrine) > hypertension
Menarche Spermatogenensis - Pheochromocytoma > increased norepinephrine >
hypertension > hypertensive crisis > stroke
7. Paralysis Terms
- Predisposing Factors:
- Monoplegic: one extremity paralysis
- Hereditary
- Hemiplegic: right/left paralysis
- Smoking
- Paraplegic: paralysis from waist down
- Signs and Symptoms:
- Qudri/Tetraplegic: paralysis from head down

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 - Hypertension - Aldosterone: promotes sodium and water
- Hyperglycemia reabsorption and excretion of potassium
- SNS like symptoms (all are ^ed except GIT)
Addison’s Cushing’s
- Mydriasis
- Dry mouth Sugar

- Tachycardia Sex
Decreased Increased
Salt
- Tachypnea
- Constipation - Addison’s Disease:
- Urinary retention - Signs and Symptoms:
- Diagnostic - Hypoglycemia
- FBS: increased - T: tachycardia, tremors
- Urinary catecholamine: increased - I: irritability
- Urinary vanillylmandeleic acid: increased - R: restlessness
- Nursing Management: - E: extreme weakness
- Monitor VS (especially BP) - D: depression, diaphoresis
- Administer medications as ordered - Decreased tolerance to stress > “Addisonian
- Antihypertensives ; beta blockers Crisis”
- Eg. Propranolol (Inderal) ; Matoprolol - Decreased libido
(Lopresson) ; Atenolol ; Nadolol - Loss of pubic/axillary hair
- Provide comfortable/quiet environment - Decreased cortisol > stimulates pituitary gland to
- Diet: avoid caffeine secret ACTH (adrenocorticotropic hormone) >
- Avoid: valsava maneuver increased MSH (melanocytes stimulating
- Surgery: adrenalectomy hormone) > increased melanin > (+) bronze like
- 12 months hormone replacement skin pigmentation
10. Addison’s Disease vs Cushing’s Disease - Force fluid:
- Adrenal cortex (outer most) - Hyponatremia
- Zona fasciculata: secretes glucocorticoids - Hypotension
- Cortisol: controls glucose metabolism) - Weight loss
- Zona reticularis: secretes androgenic - Dehydration > “hypovolemic shock”
- Testosterone/Estrogen/Progesterone: promotes - Hyperkalemia
development of secondary sexual characteristics - No banana
- Zona glomerularis??: secretes mineralo-corticoids - DOC: corticosteroids

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 - Eg. Dexamethasone ; Prednisone ; STRUCTURE AND FUNCTIONS OF THE NERVOUS SYSTEM
Hydrocortisone Nervous System
- Cushing’s Disease: - Neurons/Nerve Fiber: basic living unit
- Signs an Symptoms: • Characteristics:
- Hyperglycemia (3 P’s) > “Diabetes Mellitus” - Excitability
- Increased susceptibility to develop infection - Conductivity
- Hirsutism - Permanent cell > not capable of regeneration
- Acne/Striae - Central Nervous System: brain & spinal cord
- Increased muscularity (F) - Peripheral Nervous System: cranial nerves & spinal nerves
- Easy bruising • Somatic NS: voluntary movement
- Osteoporosis • Enteric NS: voluntary movement
- Mood swings (depression/irritability) • Autonomic NS: involuntary movement ; SNS & PNS
- Abdomina pain (GIT irritation)
- Hypernatremia Brain
- Hypertension - 3-5% of total body weight
- Weight gain - Coverings:
- Edema • Skull/Cranial Cavity (outer)
- Moon face ; Buffalo hump ; Pendulous • Meninges (inner): membranous
abdomen ; Thin extremities - Dura material
- Hypokalemia • Subdural space
- DOC: potassium-sparing diuretic (Aldactone) - Arachnoid mater
- Side effect: hyperkalemia • Subarachnoid space
- Pia mater
- Compositions:
• 80% brain mass
• 10% blood
• 10% CSF
- Parts:
• Cerebrum (largest)
- Right and Left hemisphere
- Corpus collosum: largest commissional tract

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- Functions: Parts of the Brain
• Sensory 1. Basal Ganglia: areas of grey mater located deep within each
• Motor cerebral hemisphere
• Integrative • Produces neurotransmitters:
- Lobes: - Dopamine:
• Frontal Lobe • Decrease = Parkinson’s Disease
- Controls motor activity • Increase = Schizophrenia
- Judgement, logic, rationality - Acetylcholine:
- Personality development • Decrease = Myasthenia Gravis
- Where primitive reflexes are inhibited • Increase = Bipolar Disorder
- Contains Broca’s Area (motor speech center) • Controls gross voluntary movements
• Damage: expressive aphasia (inability to speak) 2. Diencephalon
• Temporal Lobe • Hypothalamus:
- Controls hearing - Controls temperature
- Short term memory - Thirst
- Contains Wernicke’s Area (language center ; general - Appetite / Satiest cent
interpretative area) - Sleep/Wake
• Damage: receptive aphasia (inability to understand) - Blood pressure
• Parietal Lobe - Emotional/Responses (eg. fear, anxiety, excitement)
- Responsible for appreciation and discrimination of - Pituitary functions
sensory impulses (eg. pain, touch, pressure, heat/cold) • Thalamus: ats as a relay station for sensation
• Occipital Lobe: controls vision 3. Midbrain / Mesencephalon: acts as a relay station for sight and
• Insula/Island of Reil: controls visceral functions hearing, particularly the size of the pupil
- Eg. contraction/relaxation of the heart ; GIT motility ; • Normal size of pupil:
broncho constriction/dilation) - 2-4 mm (bright light)
• Rhinencephalon / Limbic System: - 4-8 mm (dim light)
- Controls smell - Isocoria = equal size
• Anosmia = absence of smell - Anisocoria = unequal size
• Dysosmia = distorted sense of smell - Normal response: PERRLA
• Hyposmia = decreased sensitivity to smell 4. Brainstem
• Controls libido/sexual urge • Pons: controls the rhythm of respiration ; pneumotaxic center
• Controls long term memory

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 • Medulla oblangata (lowest part): controls rate of respiration, 1. Alzheimer’s Disease
heart rate, vomiting, coughing, swallowing, sneezing, and - Most common type of Dementia characterized by atrophy of the
hiccups brain tissue d/t a deficiency of acetylcholine
- The site of decussation ; cross way - MC: women
5. Cerebellum (smallest part): controls balance, posture, - Predisposing Factors:
equilibrium, and gait • Idiopathic
• Tests: • Genetics
- Romberg’s Test • Viruses
• Needs 2 RN to assist • Brain infarcts (eg. stroke)
• Normal anatomical position: 5-10 mins • Toxic substances (eg. aluminum)
• (+) = ataxia or unsteady gait - Signs and Symptoms:
- Finger to Nose Test (FTNT) • Amnesia: positive loss of short term memory, intact long term
• (+) = dymetria (inability of the body to stop a • Agnosia: inability to recognize familiar objects
movement at a desired point) • Apraxia: inability to perform purposeful movement
- Alternate Supination and Pronation • Anomia: inability to rename objects/people
• Palm up and down • Aphasia:
• (+) = dymetria - Broca’s: (+) nodding > use picture board
- Wernicke’s: (+) illogical/irrational thoughts > use
Peripheral Nervous System pantomimic
1. Cranial Nerves (12 pairs) - Medications:
• Trochlear nerve (smallest) • Cholinesterase inhibitors: Donepezil (Aricept) or Cognex
• Trigeminal nerve (largest) - Best given at bed time ; Best given 4-6 weeks
• Vagus nerve (longest)
2. Spinal Nerves (31 pairs) 2. Myasthenia Gravis (MG)
• Cervical (8) - A neuromuscular disorder characterized by a disturbance in the
• Thoracic (12) transmission of impulses from nerve to muscle cells at the
• Lumbar (5) neuromuscular junction leading to descending muscle
- L3-4 : “cauda equina” or lumbar enlargement ; site of weakness ; characterized by remissions and exacerbation
lumbar puncture - MC: women 20-40 y/o
• Sacral (5) - Predisposing Factors: idiopathic ; autoimmune
• Coccyx (1) - Pathophysiology: cholinesterase destroys acetylcholine >
descending muscle weakness > MG

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- Signs and Symptoms: (eyes to lungs) • Assist in plasmapheresis (filtering of blood)
• Ptosis • Prevent complication: respiratory arrest > tracheostomy set
• Diplopia at bed side
• Mask like facial expression • Monitor for:
• Dysphagia Myasthenic Crisis Cholinergic Crisis
• Hoarseness of voice
• Respiratory muscle weakness Under medication ;
Causes Over medication
• Extreme muscle weakness esp. during activity/exertion in AM Stress ; Infection
- Diagnostic Procedures: Unable to see,
Signs and
1. Tensilon Test (Edrophonium HCl Test) 2mg/ml via IV / IM swallow, speak, and PNS
Symptoms
• The use of cholingergic/anticholinesterase agent to breath
provide a temporary relief for about 5-10 mins Cholinergic agents: Anticholinergic
• (+) = improved muscle strength > transfer to NICU Treatment - Mestinon agents:
• (-) = Organic Brain Syndrome (eg. Hypochondriasis/ - Neostigmine - Atropine sulfate
Malingering) > transfer to psychiatric ward for further - Medications:
evaluation • Corticosteroid (Dexamethasone): suppresses immune
2. CSF Analysis: ^ed cholinesterase levels response
- Nursing Priorities: • Cholinergic/Anticholinesterase Agent: increases levels of
• Airway acetylcholine
• Aspiration - Mestinon (Pyridostigmine) ; Neostigmine (Prostigmin)
• Immobility • Side effects: meiosis, moist mouth, hypotension,
- Nursing Management: bradycardia, bradypnea, diarrhea, urinary frequency
• Maintain patent airway and adequate ventilation
- Assist in... 3. Increased Intracranial Pressure
- Monitor pulmonary function test by using incentive - Monroe Kellie Hypothesis: states that the skull is a closed
spirometer container, therefore any increase/alterations in one of the
• Strictly monitor VS, I&O, neuro-check, motor grading scale intracranial components could lead to increase ICP
• Maintain side rails - Anatomy:
• Institute NG feeding via gavage • Foramen magnum
• Prevent complications of immobility (eg. Hypostatis • Medulla oblongata
pneumonia) • C1 = Atlas
• Assist in surgical procedure: Thymectomy • C2 = Axis

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- Increased ICP: an increase in the intracranial bulk brought • Stupor: decreased bodily reflexes ; generalized body
about by an increase in one of the intracranial components weakness ; can only be awaken by vigorous stimulation
- Predisposing Factors: • Coma:
• Head injury (most common) - Light coma: (+) response to painful stimulation
• Tumor - Deep coma: (-) response to painful stimulation
• Localized abscess - Forms of painful stimulation:
• Hydrocephalus • Deep sternal stimulation/pressure/rub
• Meningitis • Pressure on great toes or nail beds
• Cerebral edema • Orbital pressure
• Hemorrhage • Corneal/Blinking reflex
- Signs and Symptoms: - Conscious: wisp of cotton
• Early signs: change in LOC (confusion - restlessness - - Unconscious: instill 1 drop of saline
agitation & irritability - lethargy - stupor - coma) • Glasgow Coma Scale: quick neuro-check ; objective
• Late signs: measurement of LOC
- Changes in vital signs “Cushing’s Triad” - Motor response (5)
• ^ed BP (SBP rises, DBP same) - Verbal response (5)
- NV Pulse Pressure: 40 - Eye opening (4)
- Wide Pulse Pressure: 60 - ICP vs Shock
• Decreased HR Vital Signs ICP Shock
• Decreased RR: slow, irregular (Cheyne Stoke’s)
• Increased temperature Blood Pressure Increase Decrease
- Headache ; Papilledema (edema of the optic disk >
Heart Rate Decrease Increase
blindness if untreated) ; Projectile vomiting
- Abnormal posture Respiratory Rate Decrease Increase
• Decorticate: abnormal flexion
Temperature Increase Decrease
• Decerebrate: abnormal extension
- Unilateral dilation of pupil (uncal herniation) Pulse Pressure Wide Narrow
- Possible seizure
- Nursing Management:
- Levels of Consciousness:
• Maintain patent airway and adequate ventilation
• Conscious: awake - Prevention of hypoxia and hypercarbia
• Lethargy: obtunded ; sleepy ; drowsy
• Early signs of hypoxia:
- Restlessness

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 - Agitation 4. Parkinson’s Disease
- Tachycardia - A disorder of the CNS characterized by degeneration of
• Late signs of hypoxia: dopamine producing cells in the substancia nigra of the
- Bradycardia midbrain and basal ganglia
- Extreme restlessness - Predisposing Factors:
- Dyspnea • Poisoning (led and carbon monoxide)
- Cyanosis • Arteriosclerosis
- Assist in mechanical ventilation • Hypoxia
- Before and after suctioning, hyperventilate pt to 100% • Encephalitis
• Position: semi fowler’s or elevate head of bed 30-45 deg with • Overdose:
neck in neutral position unless contraindicated > promotes - Antihypertensives:
venous drainage • Reserpine (Serpasil): antihypertensive
• Limit fluid intake to 1.2-1.5 L/day - Side effect: depression/suicidal > promote safety
• Strictly monitor neuro vital signs • Methyldopa (Aldomet): antihypertensive
• Prevent complications of immobility - Antipsychotics: Haloperidol (Haldol) ; Phenothiazine
• Prevent further increase ICP: - Signs and Symptoms:
- Provide comfortable and quiet environment • Pill rolling tremors of the extremities (initial sign)
- Avoid use of restraints • Bradykinesia
- Maintain side rails • Rigidity “Cogwheel type”
- Instruct to avoid valsalva maneuver activities - Stooped posture
• Avoid straining of stool > Dulcolax/Duphalac - Shuffling gait
• Avoid excessive coughing > Dextrometorphan - Propulsive gait
• Avoid excessive vomiting > Plasil/Phenergan • Over fatigue
• Avoid lifting heavy objects • Mask like facial expression with decreased blinking of the
• Avoid bending and stooping eyelids (flat affect)
- Medications: • Difficulty in rising from sitting position
• Osmotic diuretics: Mannitol/Osmitrol • Monotone speech
• Loop diuretics: Lasix (Furosemide) • Depression
• Mild analgesics: Codeine Sulfate • ^ed salivation (drooling type) > suction apparatus at bed side
• Anti-convulsants: Dilantin (Phenytoin) • Autonomic changes:
- ^ed sweating and lacrimation
- Seborrhea: over secretion of sebaceous glands

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 - Constipation - Inform pt that stool/urine may darken
- Decreased sexual capacity - Instruct pt to avoid taking foods high in Vitamin
- Stages: B6 > reverses therapeutic effects
1. Unilateral flexion of upper extremity - Carbidopa (Sinemet)
2. Shuffling gait - Amantadine HCl (Symmetrel)
3. Progressive difficulty ambulating • Anti-Cholinergics: inhibits the action of acetylcholine
4. Progressive weakness - Artane & Cogentin: relieves tremors
5. Disability • Side effect: SNS
- Nursing Management: • Antihistamine:
• Maintain side rails up - Diphenhydramine HCl (Benadryl): relieves tremors
• Prevent complications of immobility • Side effect: drowsiness (adult) ; hyperactivity (child)
• Provide low protein in AM, high in PM > induces sleep • Dopamine Agonist:
(tryptophan) - Bromocriptine HCl (Parlodel): relieves tremors, rigidity,
• Increase oral fluid intake and high fiber (eg. bran and and bradykinesia
Psyllium (Metamusil)) • Side effect: respiratory depression ; seizure
• Assist in ambulation
• Safety precautions: rubber-soled shoes, low heels ; grab 5. Multiple Sclerosis
bars - Chronic intermittent disorder of the CNS characterized by white
• Assist in surgical procedure: Stereotaxic Thalamotomy patches of demyelination in the brain and spinal cord
- Complications: - Also characterized by remission and exacerbation
• Subarachnoid hemorrhage - MC: women 15-35 y/o
• Encephalitis - Predisposing Factors:
• Aneurys m • Idiopathic
- Medications: • Viruses (slow growing)
• Anti-Parkinsonian Agents: • Autoimmune
- Levodopa (L-dopa): short acting ; ^es levels of dopamine - Signs and Symptoms:
• Side effect: GIT irritation, orthostatic hypotension, • Visual disturbances:
arrhythmia, confusion, hallucination - Blurring of vision (initial sign)
• Contraindication: Glaucoma (decreases drug - Diplopia
absorption) ; MAOI’s - Scotoma (blind spots)
• Nursing Management: • Impaired sensation to touch, pain, pressure, heat/cold
- Taken with and after meals - Tingling sensation

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 - Paresthesia/Numbness • MRI: reveals the site and extent of malocclusion, and
- Mood swings, esp euphoria demyelination
- Impaired motor activity • Lhermitte’s Sign “Barber Chair Phenomenon”: confirmatory
• Weakness diagnosis ; upon flexion of the neck there is a spinal shock
• Spasticity sensation in the spinal cord
• Paralysis - Nursing Management:
• Impaired cerebellar function “Charcot’s Triad" • Provide relaxation techniques (eg. yoga)
- Tremors (intentional) • Maintain side rails up
- Ataxia • Prevent complications of immobility
- Nystagmus • Provide catheterization
• Scanning speech > let pt finish • Avoid heat application
• Urinary retention/incontinence • Encourage increase oral fluid intake
• Constipation • Provide high fiber and acid ash in the diet
• Decreased sexual capacity - Medications:
• Impaired cognition > can be improved • Adrenocorticotropic Hormone (ACTH): reduces edema at the
- Complications: site of demyelination > prevents paralysis
• Respiratory dysfunction - All steroids are given 2/3rd dose in AM and 1/3rd dose in
• Infections of the: PM > to mimic normal diurnal rhythm
- Bladder (cystitis) • Baclofen (Lioresal), Dantrolene Na (Dantrene): reduces
- Respiratory (hypostatis pneumonia) muscle spasticity
- Sepsis • Interferons: alters immune response
• Complications from immobility: decubitus / pressure ulcer • Immunosuppressants
- Pressure ulcer staging: • Diuretics
• Stage 1: Erythema • Anticholinergic Agent:
• Stage 2: Breakdown of dermis - Bethanecol Chloride (Urecholine): for urinary retention
• Stage 3: Full thickness skin breakdown • Only via SQ
• Stage 4: Bone, muscle, and supporting tissue • Side effect: bronchospasm and wheezing
involved • Monitor breath sounds 1 hr after administering
• Speech, voice, and language disorder (eg. dysarthria) • Prophanthelene Bromide (Pro-banthene): anti-spasmodic ;
- Diagnostic Procedures: for urinary incontinence
• CSF Analysis via Lumbar Puncture: ^ed IgG and CHON

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6. Cerebrovascular Accident (CVA) - Signs and Symptoms:
- Also known: • Stages:
• Apoplexy 1. Transient Ischemic Attack (3-10 mins) FAST
• Brain Attack • Headache
• Cerebral Thrombosis • Dizziness/Vertigo
• Cerebral Thrombosis • Numbness
• Stroke: partial or complete disruption in the brain’s blood • Tinnitus
supply • Visual and speech disturbances
- Incidence Rate: men (increases as they age) • Paresis or plegia
- Predisposing Factors: • Possible ^ed ICP
• Thrombus • Temporary loss of memory
• Embolus (atrial fibrillation) 2. Stroke in evolution: progression of the S/S of stroke
• Hemorrhage 3. Complete stroke / Resolution stage:
- Risk Factors: • Headache
• Hypertension • Dizziness
• Diabetes Mellitus • Cheyne Stoke’s respiration
• Atherosclerosis (narrowing of artery) • Anorexia
• Valvular heart diseases (eg. Mitral/Tricuspid valve stenosis) • Nausea and vomiting
• Post-cardiac surgery / Mitral valve replacement • Dysphagia
• Lifestyle: • (+) Kernnig’s and Brudzinki’s
- Smoking • Focal and Neurological Deficits
- Obesity (body weight of more than 20% is obese) - Phlegia
- Sedentary lifestyle - Aphasia
- Hyperlipidemia - Dysarthria (inability to articulate words)
- Type A personality - Alexis (difficulty reading)
- Oral contraceptives (prolong use) - Agraphia (difficulty in writing)
• Macro pill: estrogen • Homonymous hemianopsia > unilateral neglect
• Mini pill: progestin - Diagnostic Procedure
• Diet (high in fats) • CT Scan
• Physical and emotional stress • Cerebral Arteriography: reveals site and extent of
malocclusion
- Nx Mngt: force fluid > all dyes are nephrotoxic

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- Nursing Management: • Thrombolytics/Fibrinolytic Agents:
• Maintain patent airway and adequate ventilation by: - Streptokinase
- Assist in mechanical ventilation • Side effects: allergic reactions
- Administer O2 inhalation - Urokinase
• Restrict fluids: - Tissue Plasminogen Activating Factor (TPAF)
- ... • Side effects:
• Positioning: • Anticoagulats:
- ... - Heparin parenteral
- Provide egg crate mattresses • PTT: if prolonged = bleeding > Protamine Sulfate
- Provide sand bad and or foot board > prevent foot drop - Coumadin PO (2-3 days effect)
• Institute NGT feeding > prevent ... via gastric gavage • PT: if prolonged = bleeding > Vitamin K /
• Assist in PROM exercises q4 hrs > prevents contractures Aquamephyton
and proper body alignment • Anti-pPlatelets
• Provide alternative means of communication by: - Aspirin (PASA)
- Use of non verbal curs ; Use of “magic slate” • Side effect: bilateral tinnitus, hemolytic anemia,
• If positive to hemianopsia, approach client on unaffected side heartburn, dyspepsia/indigestion,
• Strictly monitor VS, I&O, and neuro check • Contraindication: dengue, peptic ulcer disease,
• Maintain side rails > should be padded hemophilia, pts with unknown cause of headache
• Instruct client to avoid activities leading to valsalva maneuver
• Provide client heath teaching and discharge planning 7. Convulsive Disorders
including: - A disorder of the CNS characterized by seizure with/out loss of
- Avoid modifiable risk factors consciousness, abnormal motor activity, alteration in sensation
- Prevent complications: subarachnoid hemorrhage, brain and perception, and changes in behavior
herniation - Predisposing Factors:
- Diet modification: low saturated fats, low Na, avoid • Head injury secondary to birth trauma (most common)
caffeine and gas forming foods • CO poisoning
- Rehabilitation • Genetics
- Medications: • Brain tumor
• Osmotic diuretics: Mannitol (Osmitrol) • Nutritional and metabolic deficiencies
• Corticosteroid: Dexamethason (Decadron) • Sudden withdrawal of anti-convulsant drug > #1 cause of
• Mild analgesics: Codeine sulfate status epilepticcus

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- Types of Seizure: • EEG: confirmatory ; reveals hyperactivity of brain waves
• Generalized seizure: - Nx Mngt: before (shampoo hair), avoid caffeine
- Grand-Mal / Tonic-Clonic: most common type ; body - Nursing Management:
stiffening and direct symmetrical extension of extremities • Maintain patent airway and promote safety, before seizure
• With/out an aura: epigastric pain (initial sign) acitivity:
• Epileptic cry - Clear sight of blunt/sharp objects
- Fall - Loosen clothing of the pt
- Loss of consciousness (1-3 mins) - Avoid use of restraints > can lead to fracture
- Tonic-clonic contractions - Maintain side rails (padded)
• Post-ictal sleep / unresponsive sleep > amnesia - Turn head to side > prevent aspiration
- Petit-Mal / Absence Seizure: common in children - Place tongue guard or mouthpiece > prevent tongue bite
• Blank stare - Avoid precipitating stimulation
• Decrease blinking of the eyes • Stress
• Twitching of the mouth • Trauma
• Loss of consciousness (5-10 sec) • Overexertion
- Atonic / Drop Attack • Period, Pregnancy
• Promote safety > give helmet • Sleep loss
- Partial / Focal Seizure • Electrolyte/Metabolic
• Jacksonian seizure (focal): characterized by tingling • Illness
and jerky movement of the index finger and thumb • Visualization disturbances (bright glaring lights)
that spread to the shoulder and to the other side of • Undermedication
the body • Recreation drugs
• Psychomotor seizure (focal-motor): characterized by • Ethanol (alcohol)
automatism (stereotype, repetitive, and non- • Institute seizure and safety precautions post-seizure by:
purposive behavior), clouding of consciousness, mild - Provide suction apparatus
hallucinatory sensory experience - Administer O2 inhalation
- Status Epilepticcus: continuous, uninterrupted seizure - Provide IV access line
activity • Monitor and document the following:
• If left untreated: hyperpyrexia > coma > death - Onset and duration
• DOC: Diazepam (Valium), IV glucose - Type of seizure
- Diagnostic Procedure - Duration of post-ictal sleep
• CT: reveals brain lesion • Position: side lying > promote drainage

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 • Assist in surgical procedure: Cortical Resection (a portion of • Immunizations (flu/pneumococcal)
the brain is excised to relieve seizure) - Signs and Symptoms
- Medications: • Clumsiness (initial sign)
• Phenytoin (Dilantin) • Dysphagia
- Nx Mngt: • Ascending muscle paralysis
• Only mixed with PNSS > prevents development of • Decreased deep tendon reflexes
crystals/precipitate • Alternate hypotension/hypertension > arrhythmia
• Only via sandwich method (complication)
• Instruct pt to avoid taking alcohol > can lead to • Autonomic changes
severe CNS depression - Increase sweating
- Side effect: - Increased salivation
• Gingival hyperplasia (swollen/bleeding gums) > - Constipation
provide oral care (soft bristles) ; pt massage own - Diagnostic Procedure:
gums • CSF Analysis: confirmatory ; ^ed CHON and IgG
• Hairy tongue - Nursing Management:
• Ataxia • Maintain patent airway and ventilation by:
• Nystagmus / Visual disturbances - Assist in mechanical ventilation
• Diazepam Valium - Monitor pulmonary function test by using incentive
• Carbamazepine (Tegretol): the most effective anticonvulsant spirometer
used to prevent future seizure attack • Maintain side rails
• Phenobarbital (Luminal) • Prevent complications of immobility
• Institute NGT feeding via gastric gavage
8. Guillain Barre Syndrome (GBS) • Assist in plasmapheresis
- A disorder of the CNS characterized by bilateral, symmetrical • Prevent complications:
polyneuritis (inflammation of peripheral nerves) leading to - Arrhythmia: cardiac monitor or ECG at bed side
ascending muscle paralysis ; second most common type of - Respiratory arrest: ET or tracheostomy set at bed side
demyelinating disorder - Medications:
- MC: men 30 yrs and up • Anticholinergic Agents: Atropine Sulfate
- Predisposing Factors: • Corticosteroid: suppresses immune response
• Idiopathic • Anti-arrhythmic Agents:
• Autoimmune - Lidocaine (Xylocaine)
• Antecedent viral infection - Bretyllium: blocks the release of norepinephrine

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 • Side effect: hypotension - Cataracts: opacity of the lens
- Quinidines: Chloroquine ; Premaquine • Fluids in the eye:
• Side effect: orthostatic hypotension ; dizziness - Aqueous humor: maintains intra-ocular pressure
• NV IOP: 12-21 mmHg
STRUCTURE AND FUNCTIONS OF THE EYE • Glaucoma: ^ed IOP
Function: for vision - Vitreous humor: maintains spherical shape of the eye
Structure • Uveal Coat (middle most): is the nutritive area of the eye
- Almond / Spherical shaped - Consists of:
- 2.5 mm (diameter) • Choroid body: distributes nutrients within the eye
• Iris: colored-muscular ring of the eye
Parts - Circular: smooth muscle fiber (dilate)
- External: - Radical: smooth muscle fiber (constrict)
• Orbital cavity: encases the eye • Regulates the amount of light entering the eye
• Eyebrows: protective barrier against sweat/pollutant • Retinal Coat (inner most): closely attaches to the brain
• Eyelashes: secretes an oil that prevents the eyelid from - Layers:
sticking together ; it contains meiborean gland • Optic disc / Blindspot: only contains nerve fibers ; no
- Stye / Hordeolum photoreceptors for vision
• Eyelids: opening of the upper eyelids (palpebral fissure) - Rods: located on the side of retina
• Conjunctival: outer fibrous tissue ; pink colored - Cones: located in the center of retina
- Conjunctivitis / Sore Eyes > Tobramycin/Muxifloxacin - Night Blindness (Vit. A Def)
• Lacrimal Gland: produces tears ; located at the depression of • Macula Lutea: yellowish center of the retina
the frontal bone - (+) Macular Degeneration “seeing black spots”
- Internal: • Fovea Centralis: area of retina with acute or perfect
• Sclerotic Coat (outermost): consists of vision
- Sclera/e: white part of the eye ; occupies 2/3rd of the - Retinal Detachment:
eye ; maintains the spherical shape of the eye ; refracts - Refraction: bending of light rays
light rays - Normal refraction = Emmetropia
• Inflammation: Scleritis - Errors of Refraction
• Cornea: a fibrous connective tissue ; refracts light rays • Myopia: nearsightedness > biconcave lens
• Ciliary Body/Muscle: holds sensory ligament on the lens ; • Hyperopia: farsightedness > biconvex lens
refracts light rays • Astigmatism: distorted vision > cylindrical lens
• Lens: transparent ; focuses on objects • Presbyopia: old sight > bifocal lens

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1. Glaucoma - Nursing Management:
- An increase in intra-ocular pressure that could lead to atrophy of • Enforce CBR
the optic disc leading to blindness • Maintain side rails
- MC: 40 y/o and above • Assist in surgical procedure
- Predisposing Factors: - Invasive:
• Hypertension • Trabeculectomy (eye trephining): removal of the
• Hereditary trabecular meshwork of canal of schlemn to promote
• Recent eye trauma, surgery, and inflammation aqueous humor drainage
• Obesity • Peripheral Iridectomy: a portion of the iris is excised
- Types: to allow drainage of aqueous humor
• Chronic open angle glaucoma: most common type - Non-Invasive: Trabeculostomy (eye laser surgery)
- Obstruction in the flow of aqueous humor in the - Nx Mngt (Pre): apply eye patch on the stronger/
trabecular meshwork of the canal of schlemn unaffected eye > forces weaker eye to be stronger
• Acute close angle glaucoma: most dangerous type - Nx Mngt (Post):
- Forward displacement of the iris to the cornea leading to • Position pt on the unoperative side > prevents
blindness tension on suture line
• Chronic close angle glaucoma: same as acute but long • Instruct pt to avoid forms of valsalva maneuver
duration • Monitor signs of ^ed IOP
- Signs and Symptoms: - Headache
• Peripheral vision is lost (tunnel vision) - Nausea and vomiting
• Halos and rainbows around lights - Eye discomfort
• Headache - Tachycardia
• Nausea and vomiting • Provide eye patch on both eyes
• (+) steamy/blurred cornea - Medications:
• Eye discomfort/pain • Miotics: contracts ciliary muscles and constrict pupil
• If left untreated, can lead to gradual loss of central vision - Pilocarpine Na ; Carbachol
leading to blindness • Epinephrine eye drops > decreases formation and secretion
- Diagnostic Procedures: of aqueous humor
• Tonometry: reveals ^ed IOP (NV 12-21 mmHg) • Carbonic Anhydrase Inhibitors: Acetazolamid (Diamox) and
• Perimetry: reveals decrease in peripheral vision Timoptics (Timolol Maleate)
• Gonioscopy: reveals obstruction in the flow of aqueous - Promotes increase outflow of aqueous humor
humor in the anterior chamber - Side effects: severe nausea and vomiting, drowsiness

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2. Cataract 3. Retinal Detachment
- Partial or complete opacity of lens - Separation of the 2 layers of the retina
- Predisposing Factors: - Most life threatening ; can lead to blindness
• 90-95% caused by aging (60 y/o and above) - Predisposing Factors:
• Congenital • Severe myopia
• Prolonged exposure to UV rays • Diabetic retinopathy
• Diabetes Mellitus • Trauma
• Trauma • Lens extraction
- Signs and Symptoms: - Signs and Symptoms:
• Loss of central vision • Curtain veil like vision
• “Hazy” or blurring of vision • Flashes of light
• Painless • Floaters (photopsia)
• Milky white appearance at the center of the pupil • Gradual decrease in central vision
• Perception of colors decrease - Diagnostic Procedure:
- Diagnostic Procedure: • Ophthalmoscopic Exam: reveals floaters
• Ophthalmoscopic Exam: reveals presence of cataract - Nursing Management:
- Nursing Management: • Provide comfortable and quiet environment
• Re-orient client to environment ; Maintain side rails • Assist in surgical procedure:
• Assist in surgical procedure: Lens extractions - Cryosurgery: cold application
- Extra Capsular Cataract Lens Extraction (ECCLE): - Diathermy: heat application
partial removal of lens - Scleral buckling: holds the lens and iris together
- Intra Capsular Cataract Lens Extraction (ICCLE): total - Medication:
removal of lens and surrounding capsule • Ciclopedrics: paralyzes the ciliary muscles
- Complications:
• Retinal Detachment STRUCTURE AND FUNCTIONS OF THE EAR
• Retrobulbar hemorrhage Function: for hearing and balance
• Vision loss / Blindness Parts:
• Endopthalmitis - Outer ear
- Medications: • Pinna / Auricle:
• Mydriatics: Midriacyl > dilates pupil - Made up of cartilage
• Atropine eyedrops - Passageway of sound
• Cyclopegics: Cyclogyl > paralyzes the ciliary muscles

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- External Auditory Canal / Meatus 1. Meinere’s Disease / Endolympathic Hydrops)
• Cerumenous gland: secretes cerumen (earwax) - Inner ear disorder characterized by increased endolymph
- Impacted earwax - Predisposing Factors:
- Middle ear • Hereditary
• Ear ossicles: tiny like structure that conducts sound waves • Smoking
- Types: • Allergic reaction
• Hammer / Malleu • Obesity
• Anvil / Incus • Diet: high saturated fats
• Stirrups / Stapes • Benign tumor (Cholesteatoma): formation of cholesterol in
- Otosclerosis: immobility/fixation of stapes the ear
• Conductive hearing loss - Signs and Symptoms:
• Stapedectomy: removal of stapes • Tinnitus
• Eustachian tube: equalizes pressure on both ears (open) • Sensorineural hearing loss
- Connected to the nasopharynx • Vertigo / Dizziness
- Children: short, widened and straight - Oscillopsia = true vertigo
• Otitis Media • Headache
- Adult: long, narrowed, and curved • Nausea and vomiting
- Inner ear - Diagnostic Procedure:
• Cochlea: snail shaped structure • Audiometry: reveals (+) sensorineural hearing loss
- Contains “organ of conti” (the true sense organ of - Nursing Management:
hearing) • Provide comfortable/quiet environment
• Labyrinth: • Maintain side rails
- Membranous • Assist in surgery: Labyrenthectomy
- Bony: contains vestibule (contains balance) - Complication: permanent deafness
• Kinesthesia / Position sense / Righting reflex - Medications:
(movement and orientation of the body in space) • Diuretics
• Meniere’s Disease • Anti-Vertigo: Meclizine ; Dramamine
• Mastoid Auricles: air filled spaces located deep within the • Anti-Emetics: Plasil ; Phenergan
brain • Anti-Histamine: Benadril
- Mastoiditis • Analgesics: Codeine Sulfate

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